Catabolism in critical illness: Estimation from urea nitrogen appearance and creatinine production during continuous renal replacement therapy

Leblanc, Martine; Lj, Garred; Cardinal, Jean; Pichette, Vincent; Nolin, Linda; Ouimet, Denis; Geadah, David

doi:10.1053/ajkd.1998.v32.pm9740161

Cited by 66 publications

(45 citation statements)

References 8 publications

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“…Since in rats, BUN level does not appear to vary with sex or age (59), we cannot explain the sex difference in BUN response to high doses of FOC. In humans with acute renal failure, the BUN level can be used as an indicator of protein ca tabolism (60). Although the BUN values in our study were within the reported normal range (46), the pathology data did nottot show kidney and/or renal tubu lar damage, which may have accounted for the high level of BUN in female rats (p<0.0222).…”

Section: )contrasting

confidence: 60%

Subchronic Toxicity of Fish Oil Concentrates in Male and Female Rats.

Rabbani

Alan

Chirtel

et al. 2001

Journal of Nutritional Science and Vitaminology, J Nutr Sci Vit

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SummaryThere are an overwhelming number of reports indicating the beneficial effects of fish oil supplements in human and animal nutrition. The purpose of this study, second in a series, was to evaluate the effects, particularly those that may be harmful, of high-dose, long-term consumption of fish oil concentrates (FOC) using male and female rats. One hun dred and twenty male and 120 female rats were gavaged daily with oils and oil mixtures in a volume equal to 0.5% body weight (5mL/kg/d) for 13 weeks. The administered oils were corn oil, pure menhaden oil (MO), pure MaxEPA_??_ fish oil or different mixtures of corn oil with MO. The stability and the homogeneity of the dosing solutions were tested under study conditions. The animals received isocaloric and isonitrogenous diets throughout. Food and pure water were supplied ad libitum. At the end of the in-life phase of the study, the animals were anaesthetized with CO2 and humanely killed by exsanguination. Blood and other tis sues were prepared for various clinical, histopathological and laboratory tests. Some benefi cial effects of FOC, such as reduction in total serum cholesterol, in rats were confirmed. However, we also observed a significant reduction in absolute amount of serum HDL and a significant increase in relative liver and spleen weights in both sexes with the high dose of FOC. High doses of FOC (5mL/kg/d) reduced serum iron and vitamin E concentrations. A reduction in osmotic fragility of RBC as well as an increase in RBC deformity were also ob served in rats treated with high doses of FOC. These rats showed a significant overall in crease in WBC count. We conclude that in rats, subchronic consumption of high levels of FOC can be beneficial but may also be harmful because of induction of clinical abnormalities including increased red cell deformity, increased relative liver and spleen weights, and re duced serum HDL, iron and vitamin E concentrations.

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Section: )contrasting

confidence: 60%

Subchronic Toxicity of Fish Oil Concentrates in Male and Female Rats.

Rabbani

Alan

Chirtel

et al. 2001

Journal of Nutritional Science and Vitaminology, J Nutr Sci Vit

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“…In a separate report from the same group, normalized PCR was found to increase steadily during the course of CRRT from an initial mean value of 1.55 ± 0.14 g/kg/day on day 1 to 1.95 ± 0.15 g/kg/day on day 6 [8]. The latter findings, corroborated by other investigators [47,48,50], confirmed the pronounced hypercatabolism and nitrogen deficits characteristic of this population. These investigators extended their analysis by applying formal UKM to estimate delivered dose for the same group of CRRT patients in comparison to a separate group treated with conventional HD [9].…”

Section: Quantification Of Dialysis In Aki: Continuous Therapiessupporting

confidence: 76%

“…First, the steady-state relationship between PCR and dietary protein intake in maintenance HD patients is clearly invalid for critically ill AKI patients. Nevertheless, UKM may provide an estimate of the degree of hypercatabolism and net negative nitrogen balance, both of which are characteristic of the critically ill AKI population [47,48,49,50]. Second, another fundamental component of UKM, urea distribution volume (V), is frequently deranged in the AKI population [51,52] and assumptions for this population based on values typical for ESRD patients may dramatically underestimate the degree of volume expansion.…”

Section: Quantification Of Rrt Dose In Aki Versus Esrd: Important Dismentioning

confidence: 99%

Quantification and Dosing of Renal Replacement Therapy in Acute Kidney Injury: A Reappraisal

et al. 2017

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Background/Aims: Delivered dialysis therapy is routinely measured in the management of patients with end-stage renal disease; yet, the quantification of renal replacement prescription and delivery in acute kidney injury (AKI) is less established. While continuous renal replacement therapy (CRRT) is widely understood to have greater solute clearance capabilities relative to intermittent therapies, neither urea nor any other solute is specifically employed for CRRT dose assessments in clinical practice at present. Instead, the normalized effluent rate is the gold standard for CRRT dosing, although this parameter does not provide an accurate estimation of actual solute clearance for different modalities. Methods: Because this situation has created confusion among clinicians, we reappraise dose prescription and delivery for CRRT. Results: A critical review of RRT quantification in AKI is provided. Conclusion: We propose an adaptation of a maintenance dialysis parameter (standard Kt/V) as a benchmark to supplement effluent-based dosing of CRRT. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=475457

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“…The issue has not received much attention, but two studies have utilized continuous renal replacement therapy to put ICU patients into steady state, causing the CVVH(6diafiltration)-supplied creatinine clearance rate to parallel the creatinine production rate. 27,28 The clearance was found to average 15 ml/min, 27 which is on par with the value used in case 2B. From clearance, the measured index of creatinine production was found to be lower than the same index that would be predicted by the CockcroftGault equation, by almost half.…”

Section: Fixed Creatinine Production Rate?mentioning

confidence: 69%

“…11,27 Another study found a wide distribution of results for continuous renal replacement therapy-inferred creatinine production rates; however, in most cases, the measured rates were less than the calculated rates by the Cockcroft-Gault equation. 28 These data suggest that critically ill patients with AKI have a substantial somatic protein depletion that is only worsened by a malnourished state before the development of AKI. 27 Not surprisingly then, about a third of ICU patients can have a timed urine collection that only seems inadequate (creatinine excretion ,10 mg/kg per day instead of the usual 15-25 mg/kg per day) because of their reduced creatinine production rates.…”

Section: Fixed Creatinine Production Rate?mentioning

confidence: 89%

Retooling the Creatinine Clearance Equation to Estimate Kinetic GFR when the Plasma Creatinine Is Changing Acutely

Chen

2013

Journal of the American Society of Nephrology

170

224

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It is often desirable to estimate the GFR (eGFR) at the bedside to assess AKI or renal recovery. Current eGFR equations estimate kidney function when the plasma creatinine is stable, but do not work if the plasma creatinine is changing rapidly. To analyze kidney function in the acute setting, a simple formula is proposed that requires only a modest number of inputs that are readily obtainable from clinical laboratory data. The so-called kinetic eGFR (KeGFR) formula is derived from the initial creatinine content, volume of distribution, creatinine production rate, and the quantitative difference between consecutive plasma creatinines over a given time. For that period, the deciphered creatinine excretion then yields the creatinine clearance rate. The additional formula variables needed are any steady-state plasma creatinine, the corresponding eGFR by an empirical formula, and the maximum increase in creatinine per day if anuric. The kinetic formula complements clinical intuition but also adds a quantitative and visual dimension to the assessment of kidney function, demonstrated by its analysis of GFRs underlying the plasma creatinine fluctuations in several scenarios of AKI or renal recovery. Deduced from first principles regarding the physiology of creatinine balance, the KeGFR formula enhances the fundamental clearance equation with the power and versatility to estimate the kidney function when the plasma creatinine is varying acutely.

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Catabolism in critical illness: Estimation from urea nitrogen appearance and creatinine production during continuous renal replacement therapy

Cited by 66 publications

References 8 publications

Subchronic Toxicity of Fish Oil Concentrates in Male and Female Rats.

Subchronic Toxicity of Fish Oil Concentrates in Male and Female Rats.

Quantification and Dosing of Renal Replacement Therapy in Acute Kidney Injury: A Reappraisal

Retooling the Creatinine Clearance Equation to Estimate Kinetic GFR when the Plasma Creatinine Is Changing Acutely

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